David Pomarino

New therapy concepts  toe walking

Step by step - Treatment Concept of Habitual Toe Walking


Patients suffering from habitual toe walking alternate between plantigrade and forefoot gait patterns. In this study therapists approach this gait
pattern by using pyramid insoles, physiotherapy, night splints, and infiltrations of botulinum toxin.

The initial medical examination intended for classifying toe walking patterns into three different standard types. This is followed by a therapy
based on a three-stage treatment concept. The classification method and the step-by-step concept will be discussed in detail and illustrated by
using the example of two patients. The chances of changing permanently from forefoot to normal gait patterns are shown by using the data
of 653 toe walkers, which had been under treatment in the PTZ from 2005 until the end of 2008.

555 of the 653 toe walking patients were treated with the step-by-step therapy, 98 TW (15%) were in no need of a therapy because of
spontaneous recovery. After completion of the step-by-step therapy 80% were treated with insoles, 5% of them after additional treatment
with night splints, and 2% of them after additional treatment with infiltrations turned to permanent plantigrade gait patterns.

For habitual toe walkers who first received a therapy prior to their fifth birthday , it usually took a maximum of 12 month, and for those starting
treatment after the age of five, it required a period of not more than 24 month to achieve a plantigrade gait pattern.
Patients whose toe walking patterns were persisting at the beginning of the therapy, required up to 36 months. 

D. Pomarino, M. Klawonn, S. Stock, L. Zörnig, S. Martin, A. Pomarino


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Therapy Center · David Pomarino · Research and Development · Orthopaedic Technology · Pediatric Orthopaedics
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